Are there sex differences in pain? For experimentally
delivered somatic stimuli, females have lower thresholds, greater
ability to discriminate, higher pain ratings, and less tolerance of
noxious stimuli than males. These differences, however, are small,
exist only for certain forms of stimulation and are affected by
many situational variables such as presence of disease, experimental
setting, and even nutritive status. For endogenous pains, women
report more multiple pains in more body regions than men. With no
obvious underlying rationale, some painful diseases are more prevalent
among females, others among males and, for many diseases, symptoms
differ between females and males. Sex differences in attitudes exist
that affect not only reporting, coping, and responses to treatment,
but also measurement and treatment. So many variables are operative,
however, that the most striking feature of sex differences in reported
pain experience is the apparent overall lack of them. On the other
hand, deduction from known biological sex differences suggests
that these are powerful sex differences in the operation of pain
mechanisms. First, the vaginal canal provides an additional route in
women for internal trauma and invasion by pathological agents that
puts them at greater risk for developing hyperalgesia in multiple
body regions. Second, sex differences in temporal patterns are likely
to give rise to sex differences in how pain is “learned”
and stimuli are interpreted, a situation that could lead to a greater
variability and wider range of pains without obvious peripheral
pathology among females. Third, sex differences in the actions of sex
hormones suggest pain-relevant differences in the operation of many
neuroactive agents, opiate and nonopiate systems, nerve growth factor,
and the sympathetic system. Thus, while inductive analysis of existing
data demonstrate more similarities than differences in pain experience
between females and males, deductive analysis suggests important
operational sex differences in its production.